Governors discuss phases of ACA implementation at NGA conference

Posted on August 2, 2012 | No Comments

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On July 19-20, 2012, the National Governors Association (NGA) convened 40 states and territories in Washington, D.C. to discuss a range of critical decision points and considerations related to addressing health system challenges. Over the course of two days, state officials exchanged ideas, lessons learned, and potential promising practices. Many states confirmed they are in different phases of implementation of two widely discussed provisions of the Patient Protection and Affordable Care Act (ACA) – Medicaid expansion and Health Insurance Exchanges. However, there is a high degree of uncertainty about the next steps for many states. Before committing to a particular course, states are weighing their options, factoring in additional guidance from the United States Department of Health and Human Services (HHS), and in some cases, awaiting the results of the next presidential election. Meeting participants also noted the need for greater state flexibilities and opportunities to guide the implementation of the ACA. Moving forward, states are interested in continuing to engage in meaningful discussions with HHS.

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California, Colorado, and Maryland were among the first states to enact legislation establishing health insurance exchanges under the Affordable Care Act (ACA). The Commonwealth Fund recently published a brief outlining differences in the states’ initial approaches: the numbers and types of people initially appointed to the boards governing the exchanges; the role of the board relative to the state legislature; how the exchanges interact with existing insurance markets; and the involvement of stakeholders in each state. The report also reviews the decisions that these states will face going forward, including how to finance the exchanges, how to make risk-adjusted payments to insurers for people likely to have high medical expenses, and how to avoid gaps in coverage and care for people who may have changes in income.
A new report, funded by The California Endowment through a grant to Community Catalyst, proposes strategies for effective state implementation of health reform. The report, "Where the Rubber Meets the Road: Strategies for Successful State Implementation of the Affordable Care Act," is a collaborative effort between multiple national organizations and foundations, and lays out a specifc plan for succesful state implementation of the ACA.
The National Governors Association has published a 100-page report entitled, "State Roles in Delivery System Reform."
The Department of Health and Human Services (HHS), Center for Medicare and Medicaid Services (CMS) has issued a final rule[1] addressing two previous proposed rules: “Establishment of Exchanges and Qualified Health Plans”[2] and “Exchange Functions in the Individual Market: Eligibility Determinations and Exchange Standards for Employers.”[3] The final rule addresses 1) minimum federal standards that States must meet to establish and operate exchanges, 2) the minimum standards that health insurance issuers must meet as Qualified Health Plans (QHPs), and 3) basic standards employers must meet to participate in the Small Business Health Options Program (SHOP) Exchange. CMS indicates that certain portions of the rule will be considered interim final, and the agency will accept comments on certain sections.[4] CMS also indicates in the Preamble that additional details will be made available in future guidance and rulemaking, where appropriate. For information on the proposed rules, click here. This Update describes major changes made by CMS in the final rule.
Health and Human Services Kathleen Sibelius sent a leader to congressional leaders on May 10 updated them on steps her department has taken to implement the health reform law, including expanding coverage for adult children through their parents' policies, prohibiting pre-existing condition exclusions for children, and the creation of an early retiree reinsurance program. http://www.politico.com/static/PPM153_sebelius_051010.html